Overview
- Plan issuer
- Avera Health Plans
- Child-only offering
- Allows Adult and Child-Only
- Adult dental coverage
- No
- Child dental coverage
- Yes
- Plan type
-
PPO
The Avera 4500 HSA Eligible HDHP plan is a Preferred Provider Organization (PPO) plan. If you use providers in the plan's network, you will pay less. Out-of-network health providers can be used at an additional cost. You do not need a referral to see a specialist.
- Metal level
-
Silver
The metal type provides an estimate of how you and your insurance split the costs of healthcare. Silver plans have:
- Moderate monthly premium
- Moderate costs when you need care
- Deductibles are usually lower than that those of Bronze plans
Silver plans are a good choice if you quality for 'extra savings' or if you want to pay a slightly higher premium than Bronze plans to have more of your care covered.
Contact
- Customer service number
- 1-605-322-4545
- Toll-free customer service number
- 1-888-322-2115
Coverage
Doctor coverage
- Primary care physician visit cost
- No Charge after Deductible
- Specialist visit cost
- No Charge after Deductible
- Emergency visit cost
- No Charge after Deductible
- Inpatient facility cost
- No Charge after Deductible
- Inpatient physician cost
- No Charge after Deductible
Drug coverage
- Generic drug cost
- No Charge after Deductible
- Preferred brand drug cost
- No Charge after Deductible
- Non-preferred brand drug cost
- No Charge after Deductible
- Specialty drug cost
- No Charge after Deductible
Deductible
- Medical deductible individual
- $4,500
- Drug deductible individual
- Included in Medical
- Medical maximum out of pocket individual
- $4,500
- Drug maximum out of pocket individual
- Included in Medical
- Medical deductible family
- $9,000
- Drug deductible family
- Included in Medical
- Medical maximum out of pocket family
- $9,000
- Drug maximum out of pocket family
- Included in Medical
- Medical deductible family per person
- $4,500
- Drug deductible family per person
- Included in Medical
- Medical maximum out of pocket family per person
- $4,500
- Drug maximum out of pocket family per person
- Included in Medical
Premium payment
The premium is the amount you pay for health insurance each month. This does not include other healthcare costs such as your deductible, copayments, and coinsurance.
Your premium depends on who is covered by the insurance and their ages. Generally, premiums increase if there are more people covered or if people covered are older.
Premium rates
| Coverage | Monthly premium | Annual premium |
|---|---|---|
| Child (age 0-14) | $388.10 | $4,657.20 |
| Child (age 18) | $463.19 | $5,558.28 |
| Adult individual (age 21) | $507.34 | $6,088.08 |
| Adult individual (age 27) | $531.68 | $6,380.16 |
| Adult individual (age 30) | $575.82 | $6,909.84 |
| Adult individual (age 40) | $648.36 | $7,780.32 |
| Adult individual (age 50) | $906.09 | $10,873.08 |
| Adult individual (age 60) | $1,376.89 | $16,522.68 |
| Couple (age 21) | $1,014.68 | $12,176.16 |
| Couple (age 30) | $1,151.64 | $13,819.68 |
| Couple (age 40) | $1,296.72 | $15,560.64 |
| Couple (age 50) | $1,812.18 | $21,746.16 |
| Couple (age 60) | $2,753.78 | $33,045.36 |
| Couple (age 21) plus 1 child | $1,402.78 | $16,833.36 |
| Couple (age 30) plus 1 child | $1,539.74 | $18,476.88 |
| Couple (age 40) plus 1 child | $1,684.82 | $20,217.84 |
| Couple (age 50) plus 1 child | $2,200.28 | $26,403.36 |
| Couple (age 21) plus 2 children | $1,790.88 | $21,490.56 |
| Couple (age 30) plus 2 children | $1,927.84 | $23,134.08 |
| Couple (age 40) plus 2 children | $2,072.92 | $24,875.04 |
| Couple (age 50) plus 2 children | $2,588.38 | $31,060.56 |
| Couple (age 21) plus 3 or more children | $2,178.98 | $26,147.76 |
| Couple (age 30) plus 3 or more children | $2,315.94 | $27,791.28 |
| Couple (age 40) plus 3 or more children | $2,461.02 | $29,532.24 |
| Couple (age 50) plus 3 or more children | $2,976.48 | $35,717.76 |
| Single parent (age 21) plus 1 child | $895.44 | $10,745.28 |
| Single parent (age 30) plus 1 child | $963.92 | $11,567.04 |
| Single parent (age 40) plus 1 child | $1,036.46 | $12,437.52 |
| Single parent (age 50) plus 1 child | $1,294.19 | $15,530.28 |
| Single parent (age 21) plus 2 children | $1,283.54 | $15,402.48 |
| Single parent (age 30) plus 2 children | $1,352.02 | $16,224.24 |
| Single parent (age 40) plus 2 children | $1,424.56 | $17,094.72 |
| Single parent (age 50) plus 2 children | $1,682.29 | $20,187.48 |
| Single parent (age 21) plus 3 or more children | $1,671.64 | $20,059.68 |
| Single parent (age 30) plus 3 or more children | $1,740.12 | $20,881.44 |
| Single parent (age 40) plus 3 or more children | $1,812.66 | $21,751.92 |
| Single parent (age 50) plus 3 or more children | $2,070.39 | $24,844.68 |
Source
Our data is directly sourced from Healthcare.gov, the U.S. federal government's Health Insurance Marketplace®, created under the Affordable Care Act.
- Healthcare.gov, last accessed April 1, 2021
- "The 'metal' categories: Bronze, Silver, Gold & Platinum," Healthcare.gov
- "Glossary," Healthcare.gov